Name of Policy
Policy Number
Date Last Reviewed
Date of Next Review
Responsible for Review
I.
Department of Athletics and Department
of Sports Medicine Sickle Cell Trait
Policy
00093165
June 2016
June 2018
Director of Sports Medicine
Department of Athletics and Department of Sports Medicine Sickle Cell Trait Policy
A.
Definitions
The definitions below shall have their respective meanings ascribed.
1.
“Campus Health Services” or “CHS” shall mean the University’s Campus Health
Services unit.
2.
“Department of Athletics” shall mean the Department of Athletics of the University.
3.
B.
4.
“Policy” shall mean this Department of Athletics and Department of Sports Medicine
Sickle Cell Trait Policy.
5.
“Sickle Cell Disease” shall mean a medical issue in which a mutation in hemoglobin
affects the shape of red blood cells and alters some such cells from a rounded to a sickle
shape.
6.
“Sickle Cell Trait” shall mean a benign carrier condition where one gene carries the
sickle hemoglobin mutation and the other gene is normal.
7.
“UNC” or “University” shall mean the University of North Carolina at Chapel Hill.
Overview
1.
As required by the National Collegiate Athletic Association, this Policy is intended to
provide protocols to help determine UNC student-athletes who have Sickle Cell Trait. It
also sets forth subsequent measures to be taken in the event a UNC student-athlete is
determined to have Sickle Cell Trait.
2.
Individuals with Sickle Cell Trait have only one anomalous gene from one of their
parents and usually have normal red blood cells. When individuals with Sickle Cell Trait
are involved in intense exertion or extreme conditions, the shape of their red blood cells
can change to a “sickle shape.” This change, known as “sickling,” can pose a grave risk,
as the cells can cause a blockage of blood vessels. These blockages can result in damage
to organs and muscle, causing rhabdomyolysis. Exertional sickling is a medical
emergency that can lead to various medical issues, collapse and, in some cases, death.
3.
C.
“Department of Sports Medicine” shall mean the Department of Sports Medicine within
Campus Health Services.
Sickling can begin within two to three minutes of any intense exertion. Heat,
dehydration, altitude, and asthma can increase the risk of sickling and can also make an
occurrence of sickling more severe.
Education
The Director of Sports Medicine or other appropriate Department of Sports Medicine staff
member shall annually discuss with UNC Head Coaches basic information related to Sickle Cell
Trait and management of student-athletes who have tested positive for Sickle Cell Trait.
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Additionally, the Director of Sports Medicine should instruct coaches to promptly refer to
Department of Sports Medicine staff any health concerns about any student-athlete who has tested
positive for Sickle Cell Trait.
D.
Testing
1.
Each UNC varsity student-athlete must be afforded an opportunity to be tested for Sickle
Cell Trait before participation in any athletic activity as a student-athlete at the
University. Current UNC students trying out for a varsity team or practicing with a
varsity team must also be afforded an opportunity to be tested. Such individuals who are
trying out for a varsity team shall be responsible for payment for their own test.
a.
2.
Notwithstanding the foregoing, a student-athlete or individual trying out for a
UNC varsity team may submit previous test results as evidence of whether or
not they have Sickle Cell Trait. If able to provide results of previous Sickle Cell
Trait testing deemed adequate by the Director of Sports Medicine, such an
individual may not need to undergo additional diagnostic testing.
Any student-athlete who refuses testing for Sickle Cell Trait yet wishes to participate in
athletic activities of a UNC varsity sport program must first meet with and be approved
for participation in such activities by:
a.
The Team Physician for the student-athlete’s varsity sport program;
b.
The Director of Sports Medicine; and
c.
The Department of Athletics Compliance Office.
Any student-athlete who declines testing must have a legitimate reason for doing so.
Excuses of convenience will not be allowed. In addition, any such individual must also
complete the Sickle Cell Trait Information and Student-Athlete Testing Waiver and
Release form attached to this Policy as Appendix A.
3.
E.
Individuals being tested for Sickle Cell Trait should report to CHS no later than 48
hours prior to participation in their first athletic activity as a UNC student-athlete.
Initial testing is usually conducted using a rapid screen. If the screen produces a
positive result, such test will typically be verified with hemoglobin electrophoresis. A
positive test result does not automatically disqualify an individual from athletic
participation.
Protocol in the Event of a Student-Athlete Testing Positive for Sickle Cell Trait
1.
Communication to Appropriate University Personnel
a.
When a student-athlete tests positive for Sickle Cell Trait, a written notification
shall be communicated by the Team Physician for the student-athlete’s varsity
sport program to:
i.
The Athletic Trainers for the student-athlete’s varsity sport program;
ii.
The Director of Sports Medicine; and
iii.
The Associate Director(s) of Sports Medicine.
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b.
The Head Athletic Trainer for the student-athlete’s varsity sport program shall
then communicate the positive result of the Sickle Cell Trait test to other
appropriate personnel including, but not necessarily limited to:
c.
2.
i.
The coaching staff of the student-athlete’s varsity sport program,
including the Head Coach, each appropriate Assistant Coach, each
appropriate Graduate Assistant Coach, each appropriate Volunteer
Coach, and each appropriate Strength and Conditioning coach;
ii.
Graduate Student Athletic Trainers for the student-athlete’s varsity
sport program; and
iii.
The Department of Athletics Compliance Office.
The communication referenced above in this Section shall occur at the time of
the diagnosis and annually thereafter for the duration of the time during which
an applicable individual is an enrolled student-athlete at the University.
Communication to Individuals Outside of the University
a.
b.
If a student-athlete who tests positive for Sickle Cell Trait is under the age of 18,
the Team Physician for the student-athlete’s varsity sport program shall call the
parent(s) or guardian(s) of the student-athlete to discuss the condition and this
Policy. Such parent(s) or guardian(s) of the student-athlete must then sign the
Voluntary Assumption of Sickle Cell-Related Risks form (attached to this Policy
as Appendix B) to acknowledge that this Policy was explained, all questions
were answered, and all Sickle Cell-related risks associated with continued
participation as a varsity student-athlete at UNC are assumed.
If a student-athlete who tests positive for Sickle Cell Trait is over the age of 18,
he or she must sign the Voluntary Assumption of Sickle Cell-Related Risks form
(attached to this Policy as Appendix B) to acknowledge that this Policy was
explained, all questions were answered, and all Sickle Cell-related risks
associated with continued participation as a varsity student-athlete at UNC are
assumed. The Team Physician for the student-athlete’s varsity sport program
will highly recommend to the student-athlete that such student-athlete permit the
Team Physician to communicate with the student-athlete’s parent(s) or
guardian(s) regarding the condition and this Policy.
i.
If a student-athlete is unwilling to provide consent for his or her varsity
sport program’s Team Physician to discuss his or her positive Sickle
Cell Trait test with such student-athlete’s parent(s) or guardian(s), such
student-athlete shall be required to acknowledge such refusal of consent
in writing using the Positive Sickle Cell Trait Test Acknowledgement
form (attached to this Policy as Appendix C).
ii.
If a student-athlete is willing to provide consent for his or her varsity
sport program’s Team Physician to discuss his or her positive Sickle
Cell Trait test with such student-athlete’s parent(s) or guardian(s), such
student-athlete should provide consent in writing using the Positive
Sickle Cell Trait Test Acknowledgement form (attached to this Policy
as Appendix C).
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3.
Waivers to Participate
No UNC student who has tested positive for Sickle Cell Trait at any time shall be
permitted to participate in any activity of a UNC varsity sport program without
completing and submitting to the Department of Sports Medicine the Voluntary
Assumption of Sickle Cell-Related Risks form (attached to this Policy as Appendix B).
F.
Guidelines for Participation in Athletic Activities for Student-Athletes who have Tested Positive
for Sickle Cell Trait
1.
2.
Each student-athlete who has tested positive for Sickle Cell Trait shall meet with the
Team Physician and Head Athletic Trainer for his or her varsity sport program to
discuss and document sport-specific matters related to management of such studentathlete’s participation in practices, competitions, and other athletic activities.
a.
Determinations made by such individuals about these matters shall be
communicated by the applicable Team Physician or Head Athletic Trainer to the
coaching staff of the student-athlete’s varsity sport program.
b.
The Team Physician or Head Athletic Trainer for the student-athlete’s varsity
sport program shall also provide sport-specific management guidelines to the
coaching staff and Strength and Conditioning staff for the student-athlete’s
varsity sport program.
c.
The Team Physician and other appropriate members of the Department of Sports
Medicine staff should then work with the coaching staff for such studentathlete’s varsity sport program to determine appropriate levels of individual
progression and physical activity for such student-athlete.
Each student-athlete who has tested positive for Sickle Cell Trait shall be managed,
limited when necessary, and monitored as appropriate by Department of Sports
Medicine staff during participation in varsity sport program athletic activities:
a.
In very hot or humid conditions;
b.
When such student-athlete is exercising at an altitude to which they are
unaccustomed;
c.
After any illness, especially an illness involving nausea, vomiting, diarrhea, or
other symptom(s) affecting hydration levels;
d.
If such student-athlete has an asthmatic condition or is experiencing asthmatic
symptoms;
e.
If atmospheric conditions present increased challenges for respiration; and
f.
After sleep loss.
3.
Each student-athlete who has tested positive for Sickle Cell Trait should acclimate to the
onset of conditioning or weightlifting programs by modifying his or her exercise
programs as appropriate (in consultation with Department of Sports Medicine staff as
necessary) over a period of one to two weeks. Additional accommodations should be
made in the event of any of the conditions referenced above in this Section.
4.
When a student-athlete has tested positive for Sickle Cell Trait and is unaccustomed to
the existing altitude or climate conditions, his or her training level should decrease as
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determined to be appropriate by a Department of Sports Medicine staff member.
Department of Sports Medicine staff shall ensure an oxygen tank is readily available
during all conditioning sessions, practices, and games in which the student-athlete will
participate.
5.
Each student-athlete who has tested positive for Sickle Cell Trait shall refrain from
sustained exertion without adequate rest time.
a.
G.
Such student-athletes who participate in sports which require high-speed sprints,
interval training, or other activities which induce high levels of lactic acid shall
be allowed extended recovery between repetitions.
6.
Student-athletes who have tested positive for Sickle Cell Trait should not be required to
meet performance standards in timed conditioning tests. Notwithstanding the foregoing,
any such student-athlete may participate in such conditioning activities without having
to meet time requirements.
7.
Student-athletes who have tested positive for Sickle Cell Trait shall not be required to
participate in punitive conditioning drills.
Management of Symptoms
The provisions of this Section shall serve as a basic guide to management of symptoms of any
student-athlete with Sickle Cell Trait. These provisions may be adjusted or supplemented as
deemed appropriate in the professional judgement of Department of Sports Medicine staff.
1.
Any student-athlete who has tested positive for Sickle Cell Trait shall immediately
report any symptoms associated therewith to the Head Athletic Trainer for his or her
varsity sport program or other appropriate Department of Sports Medicine staff member.
Such symptoms may include, but are not limited to:
a.
Cramping;
b.
Muscle Pain;
c.
Swelling;
d.
Tenderness;
e.
Fatigue;
f.
Shortness of breath; and
g.
Abdominal pain.
Upon the occurrence of any such symptoms which are unordinary for the applicable
student-athlete, such student-athlete shall discontinue exertional activity. If such
symptoms are believed by Department of Sports Medicine staff or the student-athlete to
be due to exertional sickling, there shall be a low threshold for removal from the
physical activity. A member of the Department of Sports Medicine staff shall have the
right to remove any student-athlete from any activity of a UNC varsity sport program at
any time in the event of a concern of possible exertional sickling.
2.
When notified of any symptoms associated with exertional sickling by a student-athlete
who has tested positive for Sickle Cell Trait, the Head Athletic Trainer or other
appropriate Department of Sports Medicine staff member shall immediately:
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H.
a.
Check the student-athlete’s vital signs;
b.
Help cool the student-athlete’s body temperature (if appropriate);
c.
Help rehydrate the student-athlete as appropriate and as can be tolerated by the
student-athlete;
d.
Administer high-flow oxygen if such means are available, preferably with a nonbreather face mask;
e.
Activate the appropriate Emergency Action Plan if the student-athlete exhibits
any signs or symptoms of decreased mental capacity or unstable vital signs; and
f.
Communicate the student-athlete’s status to other appropriate physicians and
medical personnel so that such information may be included in any subsequent
evaluation and treatment plan for the student-athlete.
Return to Participation in Athletic Activities
After exhibiting signs or symptoms of exertional sickling, a student-athlete who has tested positive
for Sickle Cell Trait may only return to participation in athletic activities with his or her varsity
sport program after he or she has been cleared to do so by the Team Physician for his or her
varsity sport program. It is advisable for a gradual return to participation in such activities to be
determined and followed, with Department of Sports Medicine staff closely monitoring the
student-athlete throughout the process.
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Appendix A
(LETTERHEAD)
SICKLE CELL TRAIT INFORMATION
AND STUDENT-ATHLETE TESTING WAIVER AND RELEASE
BACKGROUND INFORMATION ON SICKLE CELL TRAIT
Sickle Cell Trait (occasionally referred to herein as “SCT”) is the inheritance of an abnormal gene which
can cause deformation (“sickling”) of the red blood cell. According to the National Collegiate Athletic
Association (“NCAA”), Sickle Cell Trait occurs in about 8 percent of the U.S. African-American
population, and between one in 2,000 to one in 10,000 in the Caucasian population. People at high risk
for having Sickle Cell Trait are those whose ancestors come from Africa, South or Central America,
India, Saudi Arabia and Caribbean and Mediterranean countries. All newborns in the U.S. are required to
be screened for Sickle Cell Trait.
While many individuals with SCT have no symptoms or complications, there are some serious medical
concerns associated with SCT including gross hematuria (visible blood in the urine), splenic infarction,
and exertional rhabdomyolysis (breakdown of skeletal muscle), renal failure, and death. Complicating
factors include extreme exertion, increased heat, altitude, and dehydration. Between 2000-09, a reported
seven football student-athletes with sickle cell trait died during conditioning activities. Other causes of
sudden death include cardiovascular conditions, heat illness, and respiratory distress (asthma).
Through its website (http://www.ncaa.org), the NCAA has published additional information about sickle
cell trait, including educational materials and resources.
TESTING INFORMATION
Effective with the 2010-2011 academic year, the NCAA requires that each Division I student-athlete
who is beginning his or her initial year of eligibility and each student-athlete trying out for a varsity
athletic team (including transfers) must: (1) have Sickle Cell Trait testing performed; (2) show
proof of past Sickle Cell Trait testing; or (3) sign a waiver demonstrating that he or she
understands the importance of testing for Sickle Cell Trait, declines such testing, and thereby
releases the University of North Carolina at Chapel Hill (“University”) from any liability related to
declining such testing. Returning student-athletes are not required to be tested.
The SCT test (a blood test) is relatively easy to perform and can provide you with important information
that can be helpful to you both on and off the playing surface. Not only is it useful for you to know your
Sickle Cell Trait status, it also can allow health care professionals to take better care of you. For these
reasons, the University’s Department of Sports Medicine recommends that every student-athlete be tested
or provide proof of prior testing for Sickle Cell Trait. If you were born in the United States, your testing
results may be available in your medical record.
Student-athletes who have tested positive for Sickle Cell Trait are able to participate in varsity athletics,
often with no modifications whatsoever. Any student-athlete who tests positive for Sickle Cell Trait will
have a confirmatory test performed and, if such confirmatory test is positive, he or she will be counseled
on what can be done to avoid complications.
Test results will be kept confidential in accordance with the law and University policies, although the
University’s medical staff, your team’s coaches (including Strength and Conditioning coaches), and
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Athletic Trainers will need to be aware of your Sickle Cell Trait status in order to provide appropriate
attention to this issue during practice, competition and conditioning. Otherwise, your consent will be
requested before information is released.
TESTING WAIVER AND RELEASE
I,
, understand and acknowledge that the NCAA mandates
Printed Student-Athlete Name
that all student-athletes have the opportunity to learn their Sickle Cell Trait status. Additionally, I have
read and fully understand the facts above about Sickle Cell Trait and Sickle Cell Trait testing.
Recognizing that my true physical condition is dependent upon an accurate medical history and a full
disclosure of any symptoms, complaints, prior injuries, ailments, and/or disabilities experienced, I also
affirm that I have fully disclosed in writing any prior medical history and/or knowledge of Sickle Cell
Trait status to appropriate personnel within the University’s Department of Sports Medicine.
With this knowledge and information, I hereby elect not to have Sickle Cell Trait testing performed as
part of my pre-participation physical examination, despite the recommendation from the
University’s Department of Sports Medicine that such testing be performed. With this election, I
voluntarily agree to release, discharge, indemnify and hold harmless the State of North Carolina, the
University, its officers, employees and agents, from any and all costs, liabilities, expenses, claims,
demands, or causes of action on account of any loss or personal injury that might result from my decision
to not undergo Sickle Cell Trait testing offered by the University.
Signature ___________________________________________________________ Date _________________
Varsity Sport Program _________________________________________________ PID# _________________
Parent/Guardian Signature ______________________________________________ Date _________________
(If under 18 years of age)
ACKNOWLEDGED BY INSTITUTIONAL REPRESENTATIVES:
Signature ___________________________________________________________ Date _________________
Team Physician
Signature ____________________________________________________________Date _________________
Director of Sports Medicine
Signature ____________________________________________________________Date _________________
Compliance Office Representative
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Appendix B
Voluntary Assumption of Sickle Cell-Related Risks
I, the undersigned, have been informed by a representative of the Department of Sports Medicine in the University
of North Carolina’s Campus Health Services division that I have Sickle Cell Trait. I have reviewed the Department
of Athletics and Department of Sports Medicine Sickle Cell Trait Policy with a representative of the Department of
Sports Medicine, and my questions regarding Sickle Cell Trait and the Department of Athletics and Department of
Sports Medicine Sickle Cell Trait Policy have been answered.
I hereby attest that I have read and understand the Department of Athletics and Department of Sports Medicine
Sickle Cell Trait Policy. I understand and agree to abide by all provisions and requirements therein, including
immediately notifying appropriate Department of Sports Medicine staff upon the occurrence of any symptom or sign
associated with Sickle Cell Trait.
I hereby acknowledge that I have been informed of and understand the risks inherent with my participation in
athletic activities when having the Sickle Cell Trait. I understand and acknowledge that such risks may include
serious physical injury, mental injury, and death. My signature below attests to my voluntary assumption of these
risks in my participation as a student-athlete at the University of North Carolina at Chapel Hill.
In addition, I hereby release, hold harmless, and forever discharge the University, including its trustees, officers,
employees and agents, from any and all liability, claims, demands, actions, and causes of action whatsoever arising
out of or related to any personal injury, including death, in any way related to Sickle Cell Trait that I may sustain by
participating in athletic activities.
Name:
UNC Varsity Athletic Program(s):
Department of Sports Medicine and/or Campus Health Services Representative who Reviewed My Sickle Cell
Trait Status and the Department of Athletics and Department of Sports Medicine Sickle Cell Trait Policy
with Me:
Date of Above Referenced Review:
Signature:
Date:
*This form shall be completed by the appropriate parent or guardian of a student-athlete under the age of 18.
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Appendix C
Positive Sickle Cell Trait Test Acknowledgement
I, the undersigned, have been informed by a representative of the Department of Sports Medicine in the University
of North Carolina’s Campus Health Services division that I have Sickle Cell Trait. I have reviewed the Department
of Athletics and Department of Sports Medicine Sickle Cell Trait Policy with a representative of the Department of
Sports Medicine, and my questions regarding Sickle Cell Trait and the Department of Athletics and Department of
Sports Medicine Sickle Cell Trait Policy have been answered.
My signature below acknowledges my consent for information about my Sickle Cell Trait status to be disclosed to
the individual(s) identified below.
Name:
UNC Varsity Athletic Program(s):
Department of Sports Medicine and/or Campus Health Services Representative who Reviewed My Sickle Cell
Trait Status and the Department of Athletics and Department of Sports Medicine Sickle Cell Trait Policy
with Me:
Date of Above Referenced Review:
Individual(s) to whom I Give the Department of Sports Medicine and Campus Health Services Consent to
Disclose Confidential Information about My Sickle Cell Trait Status:
OR
I decline to give consent to the Department of Sports Medicine and Campus
Health Services to disclose confidential information about my Sickle Cell Trait
status. I acknowledge that my decision to decline consent may withhold important
information from University and other personnel who have a significant role in
my athletic activities. I accept all risks and consequences, including serious physical
injury or death, related to my decision to decline consent.
Signature:
Date:
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Appendix D
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Appendix E
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